目的探讨重度急性呼吸窘迫综合征新生儿的临床诊疗与生存状况。方法回顾性分析2012年4月-2014年4月期间在梧州市人民医院新生儿科住院治疗的重度ARDS新生儿患者80例,分析患儿的生命体征以及血气、电解质、肝功能、肾功能、胸片、心脏彩超、头部B超/CT等数据,比较死亡率和存活率两组患儿的数据的差异。结果 80例重症急性呼吸窘迫综合征新生儿,治愈率为66.25%,死亡率为33.75%,单个脏器受损的比例最高35.00%,肺出血与颅内出血的比例相当分别为15.00%、12.50%,胸片结果显示,肺部毛玻璃状或者斑状阴影的患儿比例为41.25%,支气管充气征患儿比例30.00%,心影消失和白肺的比例为28.75%,持续性肺动脉高压患儿比例为80.00%;患儿发病的时间在出生后0~6 h分布比例占82.50%,时间最长的患儿为出生后18 h发病,将所有患儿分为存活组和死亡组,其中,两组患儿的pH、PaC O2以及剩余碱的差异无统计学差异(P>0.05);存活组患儿PaO 2与PaO 2/FiO 2的检测结果均显著高于死亡组,存活组患儿的吸入氧浓度FiO 2显著低于死亡组(P<0.05),存活组患儿在治疗过程中,呼吸机模式从SIMV模式更换为HFOV模式的比例为7.55%,显著的低于死亡组(P<0.05),存活组SIMV模式中初定参数中FiO 2显著低于死亡组,观察组患儿PIP值显著的低于死亡组(P<0.05);两组患儿的PEEP值与心率的差异无统计学意义。结论重度急性呼吸窘迫综合征新生儿的病死率极高,尚无统一诊疗的标准,但是治疗的过程主要以呼吸机为基础,治疗前与呼吸机初定值的FiO 2均对患儿的预后的判断有价值。 Objective To investigate the clinical diagnosis and survival of neonates with severe acute respiratory distress syndrome. Methods A retrospective analysis of 80 newborns with ARDS who were hospitalized in Department of Neonatology, Wuzhou People’s Hospital from April 2012 to April 2014 was retrospectively analyzed. The vital signs, blood gases, electrolytes, liver function, renal function, Film, color Doppler ultrasound, head B ultrasound / CT and other data, mortality and survival rates were compared between two groups of children’s data. Results 80 cases of severe acute respiratory distress syndrome neonates, the cure rate was 66.25%, the mortality rate was 33.75%, single organ damage the highest proportion of 35.00%, the proportion of pulmonary hemorrhage and intracranial hemorrhage were 15.00%, 12.50% , Chest radiograph showed that the proportion of children with gross glassy or spotted shadows in the lung was 41.25%, the proportion of infants with bronchial infancy was 30.00%, the disappearance of heart shadow and the proportion of white lung were 28.75%, and the proportion of persistent pulmonary hypertension was 80.00%. The onset time of children was 82.50% at 0-6 hrs after birth, and the longest time was onset 18 hrs after birth. All children were divided into survival group and death group. Among them, two groups PaO 2 and PaO 2 / FiO 2 in survivors were significantly higher than those in death patients, and those in survivors were significantly lower than those in survivors FiO 2 was significantly lower than that of death group (P <0.05). The survival rate of ventilator model from SIMV mode to HFOV mode in survival group was 7.55%, which was significantly lower than that of death group (P <0.05) ), The FiO 2 of the initial parameters in the survival SIMV model was significantly lower than that of the death group, and the PIP value of the observation group was significantly In death group (P <0.05); no significant difference between the heart rate value PEEP two children. Conclusion The neonatal mortality rate in severe acute respiratory distress syndrome is extremely high. There is no standard for uniform diagnosis and treatment. However, the treatment process is mainly based on ventilator. Before treatment, FiO 2, the initial value of ventilator, Judgment is valuable.